Elisabeth Ubbe was a young nursing student at a Swedish hospital back in the ‘90s when a doctor instructed her to place a urinary catheter for the patient in room one. She got right on it, heading into the private room where a girl, no older than 13 or so, was waiting in a gynecological exam chair. But as Ubbe got closer, she realized there was a problem.
“I didn’t understand what I saw between her legs,” Ubbe says. “I saw a smooth, tight surface, like the skin had been burned, and a tiny hole that did not in any way resemble a urethral orifice.” The girl had undergone female genital mutilation, also known as FGM or “cutting,” but at that time Ubbe had no idea what that was. She left the room to get the doctor, who had to come in to do the catheter himself. “I’m still ashamed I didn't know how to help this girl.”
Ubbe spent the next 15 years working as a nurse midwife, with the memory of the girl buried in the back of her mind, before going back to school for photography. Right before her graduation, controversy erupted when it was reported that 60 girls at a local school in Sweden had recently been subjected to FGM. The memory of the girl came rushing back to her, and that's when she started what many think is a shocking project: making portraits of the vulvas of women who’ve experienced cutting, to expose the practice of FGM.
According to the latest figures, upwards of 200 million women and girls across the world have been victims of FGM. And while westerners largely think of it as a problem in faraway communities in Africa and the Middle East, it is a growing problem in the U.S. and Europe. In America, it is estimated that more than 500,000 women and girls are at risk of or have been victims of FGM. That’s a three-fold increase from 1990. Another 180,000 are estimated to be at risk across Europe. These numbers are reflective of immigration changes, rather than an increase in the practice itself, but they show how, increasingly, this is not just a far-flung problem — but one that affects our friends and neighbors, too.
“Without a doubt the biggest misconception about FGM is that it doesn’t happen here,” says Amanda Parker, the acting executive director of the AHA Foundation, a group founded by the author and advocate Ayaan Hirsi Ali to end honor violence in the United States.
Parker adds that this absolutely doesn’t mean we should condemn immigrant communities. Studies done in Europe show that most immigrants do in fact abandon the practice when they arrive, but Parker stresses that the cultural pressures remain for some. “Unfortunately these harmful practices are not always left at the airport,” she says. “The message is: Bring your faith. Bring your food and your holidays and celebrations. But this is a practice we cannot tolerate.”
In 2013, Congress passed the Transport for Female Genital Mutilation Act, which made it illegal to bring girls back to her family’s native country for FGM (known as “vacation cutting”) in large part thanks to the AHA Foundation’s lobbying. “Making it officially illegal can go a long way in helping parents who are feeling pressure say no to it,” Parker says. But there is still a lot of work to be done to ensure girls’ safety, and it all starts with awareness projects like Ubbe’s.
In Sweden, where an estimated 38,000 women have undergone FGM and another 20,000 girls may be at risk, it took months for Ubbe to find participants for her project. “It felt like everybody disapproved of my idea,” she says — until after many phone calls and visits to organizations working with immigrants in Sweden, she found her first subject. “She was really happy. She said, ‘It’s fine by me. I’m not ashamed of what I look like. I didn’t do this to myself.’”
Ultimately, Ubbe found and photographed three women who were willing to share their stories and their bodies with her. Because of the intimate nature of the photographs and the extreme taboo that surrounds not just talking about cutting but also talking about women’s genitalia in general in these communities, each of them has chosen to remain anonymous.
Ubbe says that there were many times when she questioned her concept. “I had to find the women and see their reaction to the process to know that this is something good,” she says.
For all three women who were photographed, it was the first time they had ever shown their vulvas to someone (outside of midwives; it is even taboo for husbands to look directly) and the first time they had ever looked themselves.
Worldwide, women’s experiences of FGM can be different based on where they are from in terms of the severity of the cutting, the age at which it occurs, and the reasons for doing it. But in general, it is an entrenched practice in parts of 29 countries across Africa, as well as smaller areas of the Middle East and Asia. It is mostly carried out on girls sometime between infancy and adolescence.
The World Health Organization categorizes the procedures themselves into four types: clitoridectomy, which is partial or total removal of the clitoris; excision, which is the removal of the clitoris plus the folds of the labia minora and sometimes the labia majora; infibulation, which is the narrowing of the vaginal opening by cutting and stitching the labia majora. The final type includes all the less common tactics, such as piercing, scraping, or cauterizing (burning) the genital area.
There is no medical benefit to any type of FGM. It only causes physical harms, ranging from lingering pain, loss of sensation, infections, urinary problems, sexual dysfunction, and complications during menstruation and childbirth. It is also associated with long-term psychological trauma.
Although some advocates of the practice use religion as a justification, no religious teachings mention it. It is instead a product of social or cultural ideas. For some communities, clitoridectomy is performed because the clitoris is thought of as a “male” or “unfeminine” organ, and so girls without it are believed to be “cleaner.” In other cultures, cutting is performed as part of a marriage or coming-of-age ceremony, with the idea being that facing the pain of circumcision is how you become a woman. In still others, it is performed as a deterrent to pre-marital sex by making sex painful — and in the case of infibulation, impossible — but also by creating an association in young girls’ minds between their sexual organs and trauma.
As misogynistic as the practice is, it’s not necessarily men alone who perpetuate it. Many circumcisers are respected older women in their communities, for example. Mothers and grandmothers often see cutting as a way of doing the right thing for girls, who must be married off to succeed. “They are not evil,” cautions Anissa Mohammed Hassan, who sits on a Swedish task force dedicated to addressing FGM in migrant communities. “You have to understand they are doing it for their daughters because if she is not mutilated she will not have a secure future.”
Hassan, who was driven to anti-FGM activism through her own experiences with it, sees Ubbe’s project as a powerful form of protest against the silence and shame that make it so difficult to stop cutting. “Normally the vagina is hidden and you can’t see it, but you can see these pictures,” she says. “And you can see how they’ve been hurt.”
Click through to view Ubbe’s photographs. Note: These images are not safe for work. Please view them with care and be respectful in the comments.
Ed. note: An earlier version of this article used the word "vagina," rather than "vulva," the more accurate term.